肝移植治疗肝细胞癌患者供肝移植结局的对比分析

Comparative Analysis of Donor Liver Allograft Outcomes in Hepatocellular Carcinoma Patients Who Underwent Liver Transplant.

机构信息

>From the Department of Hepatobiliary and Pancreatic Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; the Department of Hepatobiliary and Pancreatic Surgery, Shulan (Hangzhou) Hospital, Hangzhou, China; and the NHC Key Laboratory of Combined Multi-organ Transplantation, the Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, Research Unit of Collaborative Diagnosis and Treatment For Hepatobiliary and Pancreatic Cancer, Chinese Academy of Medical Sciences, and the Key Laboratory of Organ Transplantation, Research Center for Diagnosis and Treatment of Hepatobiliary Diseases, Zhejiang Province, Hangzhou China.

出版信息

Exp Clin Transplant. 2023 Aug;21(8):664-670. doi: 10.6002/ect.2023.0119.

DOI:10.6002/ect.2023.0119

PMID:37698401

Abstract

OBJECTIVES

Liver transplant for patients with hepatocellular carcinoma involves 3 main types of donor allografts: donation after brain death, donation after cardiac death, and donation after brain and cardiac death. Data on this topic are limited, and controversies exist regarding liver transplant outcomes in hepatocellular carcinoma patients who have received these allografts.

MATERIALS AND METHODS

Data from 490 hepatocellular carcinoma patients who received liver transplant from 2015 to 2021 at the Shulan (Hangzhou) Hospital were retrospectively analyzed. Participants were divided into 3 cohorts according to allograft type: donation after brain death, donation after cardiac death, and donation after brain and cardiac death. Kaplan-Meier and Cox regression methods were used to evaluate patient survival, graft survival, and recurrence-free survival rates after liver transplant.

RESULTS

Kaplan-Meier analysis revealed that 3-year patient survival rates were 69.2% for donations after brain death, 69.2% for donations after cardiac death, and 46.6% for donations after brain and cardiac death (P = .42); the 3-year graft survival rates were 53.3% for donations after brain death, 56.4% for donations after cardiac death, and 46.6% for donations after brain and cardiac death (P = .44); and 3-year recurrence-free survival rates were 55% for donations after brain death, 56.6% for donations after cardiac death, and 39.5% for donations after brain and cardiac death (P = .46). Complications were also similar across the 3 cohorts (P = .36). Multivariable analysis showed that intraoperative red blood cell transfusion (hazard ratio: 1.820; P = .042) and early allograft dysfunction (hazard ratio: 3.240; P = .041) were independent risk factors for graft survival.

CONCLUSIONS

Similar outcomes can be achieved for hepatocellular carcinoma patients who undergo liver transplant with donations after brain death, donations after cardiac death, or donations after brain and cardiac death allografts, especially when strict donor selection criteria are applied.

摘要

目的

对于患有肝细胞癌的患者，肝移植涉及 3 种主要类型的供体同种异体移植物：脑死亡后捐献、心死亡后捐献和脑心死亡后捐献。关于这个主题的数据有限，对于接受这些同种异体移植物的肝细胞癌患者，肝移植的结果存在争议。

材料和方法

回顾性分析了 2015 年至 2021 年在树兰（杭州）医院接受肝移植的 490 例肝细胞癌患者的数据。根据供体类型将参与者分为 3 组：脑死亡后捐献、心死亡后捐献和脑心死亡后捐献。采用 Kaplan-Meier 和 Cox 回归方法评估肝移植后患者的生存率、移植物存活率和无复发生存率。

结果

Kaplan-Meier 分析显示，脑死亡后捐献组的 3 年患者生存率为 69.2%，心死亡后捐献组为 69.2%，脑心死亡后捐献组为 46.6%（P=.42）；脑死亡后捐献组的 3 年移植物存活率为 53.3%，心死亡后捐献组为 56.4%，脑心死亡后捐献组为 46.6%（P=.44）；脑死亡后捐献组的 3 年无复发生存率为 55%，心死亡后捐献组为 56.6%，脑心死亡后捐献组为 39.5%（P=.46）。3 组之间的并发症也相似（P=.36）。多变量分析显示，术中红细胞输血（危险比：1.820；P=.042）和早期移植物功能障碍（危险比：3.240；P=.041）是移植物存活率的独立危险因素。